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The Family First Prevention Services Act of 2018 affords child welfare agencies a new opportunity to fund evidence-supported interventions to prevent children's removal into public foster care and ensure that youth in care receive appropriate treatment in the least restrictive (most family-like) setting. The new law has been generally heralded as a much-needed improvement over prior funding constraints, but there are concerns among a growing number of child welfare leaders, researchers, professional membership organizations, and advocacy groups that its focus on the families of children who are at immanent risk of removal because of maltreatment is too limiting and that overreliance on strict evidence standards may contribute to racial disparity. This article considers how child welfare agencies can best leverage the opportunities presented by Family First while addressing potential barriers posed by the paucity of evidence-supported prevention programs and avoiding the unintended consequences of limiting reimbursement to only selective prevention services that meet rigorous evidence standards of effectiveness. [ABSTRACT FROM AUTHOR]

First Steps (FS) is a brief obstetrics-based primary prevention strategy that aims to strengthen protective factors to prevent child maltreatment. This randomized controlled trial assessed how well FS services aligned with family interests and needs, how FS providers used communication strategies to build partnership with mothers, and the impact of FS on mothers' parenting knowledge in core content areas and access to services. Mothers completed a baseline survey and were randomly assigned to FS and control conditions (n = 374 and 375, respectively). The parenting education services provided to mothers were assessed by independent participant report immediately postintervention for the full FS group and by analysis of audio-recordings of the FS encounter for a subsample (n = 150). Outcomes were measured at 4 months via maternal survey. Compared to controls at follow-up, FS mothers had significantly higher knowledge scores in some areas but similar access to needed services. Few mothers lacked access to most services at baseline, and FS content was similar to that provided by other hospital personnel. FS providers' communication style promoted rapport, but providers did not tailor content to mothers' educational and service access needs. Implications of the findings for similar services are discussed. [ABSTRACT FROM AUTHOR]